Belly Up

* bellies * birth * babies * breastfeeding *

Monday, November 26, 2012

"Best Doula"

Shameless plug, go vote!
Sorry to be taking a long break from blogging, but my kids have moved into the age where I have to fight them for computer time. I have a few posts getting ready to come out but in the mean time, how about a little shameless plug for myself?!

I have been nominated in the Best Doula catagory by North Texas Child Magizine and if you have enjoyed reading this blog (and really even if you haven't...) consider voting for me!  It doesn't matter if you live in North Texas, or even if you know what a doula is.  The other ladies nominated are great too, so either way it is all good!

To vote for me, go to the link:
and, fill out the info, then choose North Texas Child Magazine.  I will there as Maria Pokluda/Great Expectations in the best doula catagory.

Thank you!


Thursday, September 13, 2012

The Finish Line

This was written by a friend of mine and I love what she wrote so much I had to steal it (with permission of course!).  She has five children now, two born via c-section, two hospital VBACs and her newest baby was born at home, and obviously also a VBAC.   I admit I sometimes cringe a little when I hear birth and athletics being compared because I don't do athletics...not 1Ks, not 5Ks and certainly not marathons, but I like her thoughts about why she compares the two.

In her words:
"Something that I have heard a lot over the last few months, those leading up to and those just after my daughter's birth, is the question of why in the world anyone would choose to birth a baby without the modern help of pain meds.  Why would anyone do that, I mean really why?? Here is my simple answer... just because. No really. I see so many women bragging on Facebook about the 5K they just finished, or maybe the half-marathon or triathlon they are working towards. They brag on the super hard workout they did today or the amount of miles they ran.

This is my own personal marathon, a challenge to allow myself to do what my body was built to do. Birth in and of itself is not a medical emergency, it is just an everyday thing that women have been doing for thousands of years. It's funny to me how in our modern world of empowered women and in the age where women can do it all and are strong and powerful (and certainly not to be seen as weaker than men) that when it comes to birth, those standards don't exist. My birth allowed me to tap into that strong woman, that empowered woman who can endure a pain that seems unbearable and still come out the victor. I will not be cheated out of experiencing the deep inner strength that comes from natural birth.

Now please before I get any naysayers,  I have had hospital births and even two c-sections so I know all about the necessity of medical intervention. In fact I have experienced birth from just about every angle.  Birth is so much more than just getting the baby out so you can move on to the holding and loving phase. It really is a deeply spiritual experience in which you as a woman find strength of which you never knew you had to accomplish a seemingly impossible task.  Now *that* is empowering, not to mention the most amazing prize you get at the end!"

I am not sure I can add much to her words.  Except that since I am most likely done having babies it might be time to go get a gym membership.

Wednesday, July 25, 2012

A Magical Birth in 3 Easy Steps

Don't you wish you could just say
abracadabra and have a magical birth?
The Magical Birth, you know the one where mom feels empowered and labor doesn't hurt much and labor doesn't last long?  Unfortunately there is no simple equation to work out that if applied then a great birth -heck maybe even an orgasmic birth, will pop out.  Don't get me wrong,  using the right inputs will go a long way to creating the desired output  (though I've yet to witness the orgasmic birth thing); but the kind of magical birth I just described is not what I am talking about in this post.

The kind of magical birth I am talking about takes place in hospitals, homes, cars, birth centers and *gasp* ORs and may or may not include pain medication.  These magical births are births where a woman feels satisfied, confident in herself and stronger in her relationships and perhaps most of all respected.  They are not perfect births or even easy births but they are usually informed births.  They may also look different for everyone, because you know... different strokes for different folks... but I can think of a few common denominators in what I would call a Magical Birth.

1.  Mom is surrounded by encouraging people that support her choices and do not create negativity.
2.  Reality matches expectations
3.  Dumb Luck 

Number #1 sounds simple enough, yet I have attend more births than I can count on two hands and  feet where couples chose to have someone at their birth that was none of those things.  Sometimes this is the careprovider, sometimes it is relative or friend.  I call this friendly fire because in most cases this is a person is someone they have hired or is someone they like.  Friendly Fire may be the OB who constantly makes comments about baby being big. Obviously not encouraging (moms generally get worried when someone starts talking about something huge coming out of their vagina).  Friendly Fire can also be the relative that tells stories about their best friend's cousin's sister's child who had some horrible event happen in labor and she wants to relay that experience to you in all its gory detail except she can't remember all the gory details, because she never really knew them.  Either way, not encouraging (and while most relatives are awesome, that example is mild compared to some of the relative issues I have seen through the years).  Research continually shows that even when a birth strays far from the original plan, those that are surrounded by people who are encouraging and respectful, will rate their birth experience well.

That leads us to the next component of a Magical Birth: Expectations and Reality colliding on the D-day.  This is where planning comes in handy as it is easy to learn what to expect at any given birth place.  C-section rates can be checked out, couples can find out from their careprovider what routine interventions to expect and which ones can be declined. While no one can know how labor will feel or progress or when the waters will rupture or any of that stuff, a couple can read up on labor and learn about the varying ways labor progresses.  It really isn't that much different than the rest of life.  We don't go to Pizza Hut and expect to order Pad Thai; if you want Pad Thai, go to a Thai restaurant. If you want a certain type of birth. choose a hospital that routinely offers that option and as much as possible know what to expect and don't expect things that are probably not going to happen

The Serenity Prayer sums up these birthing
 rules: Control what you can, accept the things
you can't and be informed so that in labor
you will know which is which. 
Ok. Dumb luck.  I don't really believe in luck but there are things that are just out of our control and those factors are sometimes the things that can leave us feeling warm and fuzzy or that leave us cold and annoyed.  We can't control the hospital staff that comes in and out of a room.  You can get a bad nurse at a great hospital (though let me say that if you pick a great hospital the odds of having a great nurse go up significantly).  You can't control if labor will happen in the day or night or if the anesthesiologist will be tied up in the OR dealing with a triplet birth and thus you have to wait 3 hours for an epidural or if someone heats up their smelly lunch in the hall outside your room or if your sister posts on facebook that you are in labor before you have a chance to alert people yourself.   When these little things go your way, that's dumb luck and sometimes you don't even notice the dumb luck until you get bad luck.  So what happens when you get bad luck?  It goes back to the first step; if a couple is respected and encouraged during the times when things are not perfect, they will probably still feel the magic. 

So there you have it, a Magical Birth in three easy steps.  Surround yourself with encouragement, have realistic expectations and consider packing that lucky rabbits foot. (And maybe just mention to your sister not to post anything about your labor on her facebook page without your permission.)

Thursday, May 3, 2012

Cinco De Mayo

So what does a holiday generally equated with liberal amounts of salsa and beer have to do with childbirth?  Nothing I suspect, though perhaps 9 months after Cinco de Mayo there is a slight uptick in births?  That thought aside, May 5th just so happens to be the International Day of the Midwife. So as a tribute to midwives everywhere, I thought I would attempt to dispel a few of the myths that surround midwives and their care. 

Make love (ie make
babies) not war!
MYTH 1- Midwives smell like patchouli, ie they are all hippie chicks. 
I can't claim that no MW has ever smelt of patchouli, but I can say none of the ones I have ever worked with have. There are certainly some proud hippie midwives in the mix but there are some proud hippie expectant moms so that works out just fine.  However, midwives come in all shapes and sizes and in all flavors of religious and political views.  They've got diversity covered (if you don't count gender anyway). Here in DFW there are probably more conservative Christians midwives than anything else but, as they say, this is the Bible Belt so that makes sense.

MYTH 2- Midwives are not trained to handle emergencies.
Midwives are trained to handle emergencies, they just are not trained to handle emergencies with surgery. Even better, midwives primary training is to prevent emergencies in the first place.  I think most of us would agree preventing the emergency is usually better than having to deal with it at all and so midwives spend a lot of time educating and preparing couples to have the healthiest pregnancy and labor possible. So for example, typical obstetrical care doesn't address gestational diabetes until it is tested around the 28th week of pregnancy, whereas a midwife will start helping mom with nutrition in the 1st trimester so that she can avoid insulin issues.  When it comes to labor, midwives bring equipment to monitor baby's heartbeat and mom's vitals, they always have oxygen (and even baby oxygen masks) and they are certified in neonatal resuscitation.  They can run IVs, deal with a post partum hemorrhage, deep suction a baby, cut an episiotomy, repair a perineum, monitor baby's blood sugars and do blood work.  Depending on the midwife, they can often even deliver a last minute turned breech baby.  Not bad!  Even better is that a midwife has been trained to help reduce the risk of all those things happening.  If an issue arises that is beyond their training, they know when and where is appropriate to get mom different care.

MYTH 3- Midwives only deliver out of the hospital,

MYTH 4 - Birthing with a midwife means mom better just bite the proverbial bullet pain wise.

Hi mom, hi dad!  Hi midwife!
MYTH 5 - A couple cannot have a sonogram if they birth with a midwife.
I will answer all these together.  There are various types of midwives, and their licensing varies from state to state.  I am a TX girl and so most of what I say is about TX and not necessarily all 50 states.  Certified Nurse Midwives (CNMs) often deliver in hospitals and operate similarly to an OB in terms of type of office.  These CNMs offer moms the option of birthing in a hospital, access to an epidural, narcotics, pitocin and of course natural birth along with the more personalized care of a MW. In most states they can also write prescriptions.  Other CNMs will choose to solely attend deliveries out the hospital.  Obviously out of the hospital, the epidural is off the table, but moms can choose to receive narcotic pain meds.  Certified Professional Midwives (CPMs) only attend out of hospital births and they cannot write prescriptions, however they do blood and lab work and many do their own sonograms as well.  Either way, you can catch a glance of Junior in the womb.

MYTH 6 - In an emergency I can get help more quickly if I am at the hospital and have an OB.
While it is true that one will be at a hospital more quickly if one is already at a hospital, it is also true that the OB most likely will not be there.  OBs typically do not head to the hospital until baby's arrival is imminent so if a true emergency occurs before that moment, help from an OB is as close, or far, away as where the OB lives or offices...or takes his family out to dinner or plays golf etc. In an out of hospital situation, it is likely that a mom transporting in will arrive about the same time as an OB. The midwife will have called ahead and everything will be prepared for whatever the next step needs to be.  One bonus to midwifery care is that a midwife will be with mom during her active labor and if anything looks off the midwife should pick up on it quickly and can take action to fix the issue or make the move to seek assistance. 

I do know that there are some OBs that practice more in a midwifery style and some midwives that have less of the personal and preventative approach.  However, since this is a day of celebration, I will just leave it at that.  Happy Day of the Midwife...and pass the chips and salsa!

Monday, April 16, 2012

Beyond Healthy Babies and Healthy Moms

Yes, there is really is a ribbon
for everything, including cesarean awareness.
April is National Cesarean Awareness Month, so it seems as good a time as any to wade into a topic I have wanted to write about for a long time but that I have feared writing because the topic is more personal for many women than my typical posts.  I want to talk about why birth matters and I admit  I also want to respond to any person who has ever made a comment such as, "If baby and mom are healthy then that is all that matters...who cares how the baby got here?"  I am here to say that many people *do* care and that more should. 

Having a vaginal birth is not just about the warm fuzzy feelings a woman gets by pushing a baby out, though these do often come as part of childbirth (but not always).  However the experience is secondary to the life long health benefits that a vaginal birth can provide for both the mother and child.  As I do know many women, either by choice or through circumstance, have had c-sections it is important to say that I am not discussing these benefits in order to say that one group of women are better moms or that another group has children that are  ________ (fill in the blank with stuff like smarter, healthier etc) than others.  It isn't about that...really!  However in society's efforts to not hurt people's feelings, we miss the point that women need and deserve to know the truth.  We should be hearing this truth from our health care providers but all too often we are not.  Birth does matter!

Just a few stats:
Physical risks to mom during or caused by a c-section:*
-  double the blood loss as compared to vaginal birth,
-  1 in 25 women will need a blood transfusion
-  1 in 3 women will develop an infection on their incision or internally
-  1 in 154 will need a hysterectomy
-  1 in 2500 women die during a c-section vs 1 in 10,000 in vaginal birth.
-  increased risk for placenta increta, accreta and percreta which are life threatening 
-  increased risk for anesthesia complications and rehospitalization
-  abdominal scar tissue can create lifelong pelvic pain, bladder/bowel issues and pain during sex

Physical risks to baby:
-  respiratory distress syndrome
-  iatrogenic premature
-  persistent pulmonary hypertension
-  lacerations on the baby
-  babies born via c-section have higher rates of asthma and allergies
-  duration of breastfeeding is markedly lower for babies that were delivered via c-section.  (the risks of not receiving breast milk is longer than I can begin to address in this post.)

Physical risk to subsequent babies:
- increased risk of infertility and ectopic pregnancy
- increased risk of still birth, low birth weight and prematurity
- increased risk of having malformations or central nervous system injury

Not a short or fun list!. 

Women have feelings...
and they are not all the same.
Now, lets top that by getting emotional.  Some women will choose to have c-sections for little to no reason at all; others will want to avoid one if at all possible.  Others will be fine with the idea of their labor ending in a c-section if they feel it was needed but still find themselves disappointed or perhaps struggle with the difficulties of recovery and/or nursing issues caused by that recovery. Often when a woman has a c-section she feels like her body failed, that she failed her body...or that she failed her baby. She may grieve the experience and she may second guess herself or her careprovider. She may be happy, she may be sad, she may be angry, or she may be a confusing mix of all of the above.  However, what she is NOT is any less in love with her child or any less grateful to be holding him than the mom who doesn't express any grief over her experience.

Some people reading this will have had a c-section and think it totally rocked, and if that is you I am truly thankful that you had an good experience.  However, if you are someone who has ever made a comment to another woman about a healthy baby/healthy mom being all that matters, then please continue reading.  I truly believe that this type of comment is made in the spirit of encouragement, but it does the opposite as it expresses an underlying tone that mom's emotions are not acceptable and that as long as her baby is healthy that she does not deserve to feel emotional pain or to struggle with her physical recovery.  It also discounts the very real advantages of a normal vaginal birth and that a new mom has every right to at least feel a little sad that her baby missed no matter the reason her baby was not born vaginally.  

Yes, a healthy baby and healthy mom are the most important thing, but not the only thing.  A soldier coming home safely from the battleground is happy to be home, but his current state of health does not discount what he went through while he was there.  So if you have a friend or relative that has an unexpected c-section, ask her how she feels about it when you visit the new baby.  Affirm her feelings whatever they may be, even if they are different than how you think you would feel in her shoes. 


Friday, February 24, 2012

Pit is (not) Evil

I admit it, I am sucker for this type of  moment.
Did I type that title?  Yes...pitocin in and of itself is not evil.  I do hope that anyone who is reading this post about pitocin will go back and read Pitocin Part 1 ( ) as they really do go together, however the truth is that some women need inductions and sometimes the risks of a pregnancy continuing are higher than the risk of whatever it takes to get that baby out. Of course too often the risks of a continued pregnancy are over emphasised while the risks of induction are often under emphasised (or not mentioned at all) but medical reasons to induce do exist.  Another reason to induce is that a woman may have reason to request an elective induction.  I am going to stand by this reason, though I may sometimes be standing by scratching my head.  I 'll also just admit that I am sucker for those hallmark moments where a father is about to be deployed and wants to meet his child before he is put in harm's way.  Given that penchant for sentimentality and the reality that elective inductions *do* happen, I will leave that topic for another day and continue addressing using pit for good and not evil.

The biggest pro of pitocin is that for a woman who needs to deliver her baby, pitocin offers a fairly reliable way to get labor going.  Used in conjunction with other drugs and interventions, it offers women a chance to have a baby on-demand that does not automatically involve major abdominal surgery.  Yes it increases the odds of having a surgical birth as compared to spontaneous labor but if a c-section is scheduled the chance of a c-section is the odds are more in favor of a vaginal birth with a pitocin induction.  Pitocin gives these women a chance for a vaginal birth and all the benefits that come with it.

If your OB looks like this,
it is probably best to say
no to the pitocin
A common theme I hear from women is that once they are told they are going to be induced they feel it will be impossible to have a natural birth, and by natural I mean pain med free - not a birth sans drugs since obviously pitocin is a pharmaceutical.  I would argue that in an induced birth it is even more important to delay or forgo an epidural in order to increase the odds that the induction will be successful.  Yes, mom will have to get creative but the constant fetal monitoring that comes along with pitocin still gives women room to stand, do a bit of walking and swaying and the bed itself offers endless position opportunities.  Her pelvis is at a disadvantage already because it doesn't have all those lovely labor hormones to help it stretch, so whatever mom can do to help it will be appreciated by her baby and her pelvis.

However, contrary to popular belief, the contractions caused by pitocin are not stronger than those of normal labor, they just become intense and closer together more quickly and unlike a spontaneous labor they don't ebb and flow as much.  An induced labor that is going well will probably look like the active to transition stages of labor from early on and this is where pit gets its bad reputation.  The good news then is that a pitocin induction is usually shorter than a spontaneous labor so if a mom can see the "light at the end of the birth canal" she can deal with these contractions just as a woman can deal with the contractions of late labor....induced moms just get there quicker (or not at all depending on how mom/baby respond to the meds of course). 

Pit is also used commonly to augment, or help intensify and make a labor more effective.  This method is way over used (especially in 1st timers) due to false obstetric expectations of the course of normal labor, however there are labor patterns that will benefit from pit.  Well timed pit truly helps some women avoid surgical birth.  Perhaps if these moms were given endless days to labor and the full compliment of chiropractic adjustment, nutrition and proper relaxation they would deliver, but most women are literally exhausted after a day or two of labor and lack of sleep, especially if they do not have an epidural.  These are the women that have no energy to push even if they eventually reach full dilation (though being able to eat and drink at the hospital would certainly help in this regard!) .  Usually a little pitocin will get these moms to the finish line with enough energy left to push out a baby thus avoiding a c-section or assisted delivery.

So my final thoughts regarding pit:
* If you are having labor induced, be nice to your pelvis and say no the epidural for as long as possible.  If you had your heart set on a natural birth, don't give up just because pitocin is a part of your new birth plan.  Instead get a new mindset and get creative.

* If the choice is laboring to the point of exhaustion just to avoid pit, really think through your options and make an informed choice about the use of pitocin in your labor.  A little pit is occasionally the difference between a vaginal birth and a c-section.

* Most importantly, pitocin is way overused in births.  It carries risk and is often given unnecessarily and in a way that increases the inherent risks of the drug.  Choose a careprovider that does not routinely use pitocin in the way,

Wednesday, January 25, 2012

Pit Stop (Pitocin Part 1)

Pitocin is now used to induce or augment over 80% of labors in the United States.  It is used in even higher numbers post partum as a prophylactic for excessive bleeding or hemorrhage.  If a woman is having a hospital birth in this country, the likelihood of pitocin being a part of her birth is extremely high.  So what exactly is this drug that is used so frequently these days?
When the Beatles sang "All You Need is Love",
I bet they were singing about oxytocin.
Pitocin is synthetic oxytocin, so let's take a quick detour and talk about the real thing before we look at the synthetic counterpart.  Oxytocin is the hormone that, among other things, helps initiate and regulate labor.  Naturally occurring oxytocin originates in the brain then is produced by the pituitary glands and is sent out from there to various oxytocin receptors throughout the body.  Oxytocin is also known as the "love hormone" as it promotes romantic, sexual and familiar attachment.  It bonds husband to wife, parent to child, etc. Humans secrete oxytocin when we touch each other, when we have sex, and in huge quantities during breastfeeding, spontaneous labor and immediately after childbirth.  Oxytocin makes us feel secure, loved and overall less anxious. Research is even being done connecting the lack of oxytocin in those with autism.  In fact, the drug XTC is a derivative of oxytocin.  If you don't know what I am talking about, good!  XTC is an illegal drug that makes users want to dance and party all night long because they are just so....x-static.  Seriously, this oxytocin is good stuff!

Pitocin, fondly (or not so fondly) referred to as pit, is the synthetic form of oxytocin.  Pitocin is a uterine stimulant and causes uterine contractions by changing calcium concentrations in the uterine muscles.  It is derived from extractions of the pituitary glands of non-human mammals and is generally given through IV or an IM injection.  During the course of normal labor oxytocin is released through bio feed back loops that exist between the cervix, the uterus, the brain, the pituitary gland and the baby plus all  the other hormones in the mix.  This process is complex and not completely understood; we have yet to even identify what exactly makes labor start.  So far it seems to be one of those chicken or the egg type dilemmas. Did the oxytocin create the labor or did the labor create the oxytocin?  We do know that in spontaneous labor oxytocin will ebb and flow as the body responds to labor and will slowly build so that contractions become closer and a baby is ejected.  Of some interest is that oxytocin cannot cross the blood brain barrier.  Therefore synthetic oxytocin is not recognized by the brain which leads to an interesting thought that a women induced with pitocin may be laboring, however her brain may not really know it.  This lack of complete biological communication may then create some challenges in those hormonal and bio feed back loops that typically make labor effective. 

The dosage of pit given varies widely based on provider's individual protocol.  The suggested dose is to initiate the pitocin at 0.5-1 mU/min and increase it at 30-60 minute intervals by increments of 1-2 mU/min until the desired contraction pattern has been established. As labor progresses to 5-6 cm dilation, it is suggested the dose should be reduced by similar increments. Studies of the concentrations of oxytocin have shown that infusion rates up to 6 mU/min give the same oxytocin levels that are found in spontaneous labor and therefore higher rates should be given with great care.

If you have attended a pitocin induced birth or had one yourself, you're probably scratching your head...that is not how pit is typically administered in the real world.  6mU/min is closer to most starting doses rather than the final dose and almost never will you see careproviders turning the pit down after it has been turned up.  Not being someone with the authority to make dosing decisions myself, I don't want to overstep my knowledge, but if a mom is in a induction situation and the pitocin is going up and up and up, the issue may be that mom has an impatient care provider and not that her uterus is working poorly.  If you are considering an induction with pitocin, you will want to have a little chat with your careprovider about how he typically manages the use of pitocin and how he will do so in your unique situation.

There are a few other side effects listed for pitocin:  allergic reaction; difficulty urinating; chest pain or irregular heart beat; difficulty breathing; confusion; sudden weight gain or excessive swelling; severe headache; and excessive vaginal bleeding.  Luckily, these side effects are fairly uncommon.  However the side effects that I want to highlight won't be found on the package insert.  These include the need for an IV and IV fluids - which limit movement, the need for mom to have continuous fetal monitoring- which will  limit  movement, and depending on how the careprovider doses the pit, contractions that are so frequent that mom will experience more discomfort with less time to rest between contractions than would be typical in a natural labor.  This usually leads to an epidural and the side effects of that epidural (need for a bladder catheter, pulse oximeter, lowered blood pressure, possible itching and shakiness and of course even less ability to move.)

Another side effect can be that it doesn't always work.  If a women is induced and she fails to completely dilate it is called a failed induction.  The remedy for that is usually a c-section particularly if the induction included the breaking of baby's amniotic sac. Also common is that babies don't tolerate the increased frequency of high dosage pitocin and show signs of fetal distress.  The remedy for this is usually a c-section as well.  I don't consider it too big of a statement to say that a common side effect of pitocin use is major abdominal surgery, particularly for first time mothers..

However, after doing some trash talking about pitocin in this post I must insist that your read Pit Stop Part 2 which I am almost done writing.  I may have to turn in my natural birth advocate card after hitting publish, but I am going to talk about pitocin in a good light.  Oh yes, I am....stay tuned.

Thursday, January 12, 2012

Fads At 40

Looking like this
was a fad in the

Forty weeks that is!  As mom gets close to that magical date of 40 completed weeks of pregnancy it seems several concerns tend to come up by careproviders, usually in the context of  "We may need to induce because....(fill in the blank)....." 

Major disclosure here.  I am not a doctor, I am not a midwife...I am barely even a midwife student.  I am not saying that if you are told you might have any of these issues that they are not real or a potential concern.  I *am* saying that if they come up that I suggest doing some research and perhaps even getting a 2nd opinion before you make choices about scheduling an induction or a c-section as the risks of those procedures may carry risks higher than the risk of the original potential concern.  Even better, think about them before they are brought up so you can better discuss your options if and when they do. There, my legal disclaimer. Please don't sue me.

I hear a variety of things said to my friends and clients as to why they should induce either before or by their EDD, but a few keep coming up and I will call those the Fads at 40 because these seem to be the "in" reasons given for inductions right now.  These inductions sound medically legit and there may indeed be some medical basis for the concern but they are areas where the research is either inconclusive or has outright shown that the concern is not a reason to induce.  In the end the real reason may boil down to to a careprovider covering his assets, so to speak..  So what are my the top Fads at 40?  Here you go:

1) Your baby is too big
Nobody gives birth
to a toddle
What is too big?  Obviously this is a very subjective.  A baby and mother will work together in labor to birth and at the point the size has a lot less to do with the baby navigating through the pelvis than its position and the circumstances surrounding the labor.  ACOG defines a "big baby", or macrosomia, as a birth weight of  8 lb 13 oz to 9 lb 15 oz.  However macrosomia in medical terms, is not bad in and of itself, and the real thing to understand is that studies show time after time that there is NO way to accurately weigh a baby in utereo.  Sonograms are often characterized as accurate late in pregnancy, but the research shows otherwise. If a provider says a baby is big (or small for that matter) based solely on sonogram measurements, that statement is not much more than a guess.

Moms that have gestational diabetes have more concern in this area as they can grow babies that are bigger due to that condition than they might have otherwise, so this is something to consider if you are suspected to have macrosomia.  However if you are not diabetic and ate healthily, you probably grew the right size baby for you, even if it is 10lbs.  ACOG also recommends against inductions for large babies so if your careprovider recommends an induction for macrosomia he is going against the standard of care as well as the logic that for a bigger baby you will want to reduce the need for an epidural because the supine position used with an epidural will reduce the pelvic dimensions giving baby and mom less resources to do what they need to do.

I know the idea of having (ok, pushing out) a big baby scares many moms, but really even tiny moms can deliver huge babies just fine and often without tearing given good positioning and support.  If you need more of a pep talk on how much our pelvis's rock, go back and read the post 
2) You don't have enough amniotic fluid
Amniotic fluid is a tricky and sometimes controversial subject.  The normal range for an AFI (amniotic fluid index) is 5-25 with low levels sometimes associated with placental insufficiency as the pregnancy reaches term and beyond.  However, fluid levels fluctuate almost hourly and obtaining a reading is very subjective based on who is doing the measuring and the position of the baby not to mention when in the day it is done.  To confuse matters more, what the reading actually means is very subjective as well.  In a term pregnancy, some providers consider 7 or below a low reading, others 5 and below and many don't even bother to measure the fluid until the pregnancy gets past 41 weeks.  Then there are a few others who are more conservative and want to see a 10 or higher. You can see how an induction based on fluid levels alone should really be explored before going forward!

If mom is testing on the lower end of her care provider's comfort level, other tests can be done to get an overall picture of the health of the pregnancy.  A mother can also increase her fluid intake either orally or with IV fluids for a period of time and have the fluid tested again at a different time of the day to compare results. Obviously if the care provider is one of whose comfort levels is on the very high end, the couple will have to have some discussion about their own comfort levels and then see if they can work things out with their current provider.

3) Its 40 Weeks and Nothing is Happening
Neither babies nor their moms
come with a printed expiration date
I've written about this one before so I won't be"labor" the point.  If your cervix is closed up tight at 40 weeks it means nothing.  The cervix will dilate when contractions start and when contractions start  has nothing to do with how open, or closed. the cervix is.  Cervixes react, they don't initiate.

A woman who is induced because her body is showing no sign of being ready usually means she will have a failed induction and a c-section...because she wasn't ready, particularly for 1st time moms.  If a careprovider suggests an induction because nothing is happening yet, yet, just remember that no one stays pregnant forever.  If a careproider suggests an induction because mom is 4cm and not yet in labor, just remember that babies don't fall out.  (unless you are 16, at the prom and didn't actually know you were pregnant.) It is fine to walk around at 4cm for as long as it takes for labor to start.

4) Nothing Good Ever Happens Past 40 Weeks
Normal gestation is 38-42 weeks so good things certainly do happen after 40 weeks.  Things like spontaneous labor.  It's a cliche in the birth world, but it's true: EDD stands for estimated due date, not expiration date.